Thursday, May 22, 2008

desolation row

over the last couple weeks I have been accompanying a friend while he's been conducting home visits. my friend is a physician and we are working on a project which is aimed at discussing the value of visiting 'patients' in their homes. since I am a visual type of person, I suggested that we spice up the presentation with some images - there is much truth to the proverb of a picture is worth a thousand words.

for years I worked helping with the training of medical students and resident physicians. my experiences, observing and working with physicians and the people they care for, has been exclusively in clinical settings. however, I have done other work where I have interviewed people in a variety of settings; interviewing someone in their home has consistently been my favorite setting. I have found rapport is easily established when respondents are comfortable and most folks are quite comfortable when they are in their own space. my own experience with medical 'home visits' has been limited and completely personal - e was born at home, my midwife conducted all my prenatal and after birth visits at our house; I also was privileged to be with my grandmother on several occasions when her doctor dropped by her house for a home visit.

perhaps because of my own experiences, the notion of taking care of folks in their own home has always appealed to me. however, I feel that despite an entire industry arising around 'home care,' medical visits by established 'health professionals' (e.g. physicians, nurse practitioners, etc.) are not very common/widespread. authentic home care by medical professionals, I believe is yet another area where our current health care system is lacking.

my friend is a geriatrician and a family practice physician (a doctor trained to care for people 'from the cradle to the grave'), most of the folks we have been visiting are elderly and are frail with mobility issues. it has been a wonderful experience to go around with my friend while he's doing his home visits. however, it has also made my heart very heavy. the majority of the folks we have visited have been poor, and it is heartbreaking to see not only how isolated many our elders are but the condition of some of their environments, through no fault of their own.

the picture of these broken steps is at the home of an 83 year old woman who is wheelchair bound, there's a sign on the door that says to use the back door. the back entrance is barely an improvement, although there are no broken steps there are steps and the passage is quite narrow. getting the woman, who I will call ruby, in and out of her home is a major production and requires the assistance of multiple individuals. despite the desolate state the house, the number and nature of her health problems, and the fact that she was is essentially a prisoner of her house, she is bright, generous of spirit, and surprisingly optimistic.

while my friend had to field a few telephone calls, I had the opportunity to hear a bit about ruby's life. I heard a story of strength and survival. like many african-americans, ruby moved from the deep south to the north in the 1940s. when she arrived in cleveland she started driving a taxi cab; after a time she no longer was no longer willing to drive the cab (she attributed her change of work as a mixture of some safety issues and extremely poor pay). she eventually started working as a domestic and a home child care provider. what I found beautiful in ruby's story is the enduring power of her generous spirit. her only son lives two hours away and she has few relatives in the area, but she is far from feeling alone. her 'children,' white, black and ranging from their twenties to their late forties, stay in touch. it is clear that although this woman had little in terms of material offerings to give to others, she gave love and gave of herself. I heard a story of how someone's giving spirit can give back years later. unfortunately, most elderly folks in ruby's situation haven't built up this amazing family of 'fictive' children. and unfortunately, the kids ruby raised never made it big financially, as it doesn't look like any one has been able to help ruby with some needed structural improvements. but on a positive note, while we were there, a man from a new pilot (read potentially temporary) program to help seniors improve the safety of their homes was also visiting. perhaps it won't be long before ruby's steps are fixed and a ramp for her wheelchair is put in - he left with quite a list and some very encouraging words of what ruby can look forward to.

the picture above is another house we went to. coincidentally, the person living in the house is another wheelchair bound woman in her 80s. this woman has lived in this house for over fifty years. in all those years, she has never been late with her rent, but being a consistent and tenant has meant little to her landlord. in all the years her landlord has never invested anything to maintain or improve the structure of the building.

what is it with this country of ours; billions (if not trillions) of dollars are being spent so the u.s. can occupy and wage a war in a foreign country, supposedly so we can 'save' iraq and help it become 'free' and so their people can experience the fruits of democracy and freedom. however, here in our own country, we have millions of people who are not free - people are shackled by multiple systems in crisis. our health care system is in crisis - we have 48 million people uninsured (many more underinsured), the costs of delivering health care in the united states are exorbitant compared to other countries, and despite spending more per capita on health care in the u.s. than any where else, our ranking on key health indicators is no where near being near the top. we have a housing crisis - and the crisis is not confined to foreclosures, decreasing sales, and market plateaus. according to the national low-income housing coalition one third of the nation's population (95 million people), have housing problems including a high-cost burden, overcrowding, poor quality shelter and homelessness. well I could go on about some of the other crises - transportation, global warming, educational, put I think this has turned into enough of a rant. geez, some days I seem to start off okay, but then I never know where I'm going to go end up! what had me started was thought of some homes I've been in lately and the new folks that I've met whose stories have touched my heart. oh my.....

10 comments:

I found it a balanced entry, love, hope, trauma and stress. Made it much food for thought.

Yes indeed and to my shock and horror in my classes with the up and coming politicians of Canada I found that many of these young bright minds actually want to be more like the states!!! They are all for privatized health care. They are all for privatization of our resources and management of our parks, electricity and it scares the hell right out of me.

And then I see how our military that was for the most part "Peace Keeper" are now being promoted as fighters in commercials who will fight for injustice, fight for peace, fight fight fight fight fight. What a fright!

It was good to read this and good to read the comments from colette amelia. I couldn't help thinking of our dear friend in Montréal who just wrote about her physical ordeal caused by careless repairs and a fractured 85 year-old humerus. She ends her email with the following comment: " with all the flaming pills I have to take I seem to be slowing down but apart from that I am okay and still enjoying life and my glass of wine!"May we all live to be like Ruby and Suzanne - amen.

It makes you realize when you're looking to give, you really don't have to look very far. I think of all the times we give to large organizations when we could simply spend the money building a ramp or fixing a leaky roof. Habitat had a small local program for that in some states, where volunteers would do small repairs at an elderly person's home, but no landlords were involved. When an elderly person is renting a home it is even a more dire situation. At the mercy of an uncaring, greedy landlord who has control over the living space.

I was shocked at the way some people lived in my county when I visited homes with habitat. Exposed wiring, dirt floors, no heat besides old kerosene heaters, no indoor plumbing, no kitchens in some homes,--and because these people owned the property and paid their taxes every year with their meager funds, our government considers them well off home owners. These shacks are worthless, and if they could sell the land they sit on (often in a wooded area behind other homes) they could never ever live off the proceeds) One woman was living with her daughter and grandchildren. The daughter earned a few dollars "too much" per month to get help from the government, which would takes years to process anyway.

These are the hidden poor--tucked away behind McMansions, in the wasteland strips along the freeway, and up in the hills. And we are a wealthy county, so this makes no sense. It seems the last people who get our attention are the poor and the elderly.

I love the very wabi sabi truck at the top. We have more than our share of housing -- or the lack of it -- problems in San Francisco. The shrinking middle class is a stark reality here, and we have so many dualities such as Atherton/East Palo Alto or Carmel/Castroville, where rich and poor live next to each other until the near-rich push out the poor and then complain that they can't find good service workers.

ca - it is a great tragedy that canada's politicians would consider using the catastrophes in the u.s. as a model! and yes, all around what a fright!

river - thanks! here! here! to ruby and suzanne - may their spirits infect us all!!

sourire - glad you were interested and thanks for taking the time to comment! heartwrenching and heartbreaking.....I wonder if there's a group like the one ched mentions here in cleveland? if so I'm definitely interested in signing up!

ched - I'm definitely going to see if we have a habitat group for repairs in the area....I'm quite handy with tools and have even done sheetrocking! I'll be signing up, if so.even when the poor aren't hidden, our society has an amazing ability to render them invisible. it is an amazing feat...

junk - that old truck pic is one of my favorites...it has such character like all folks that I have been meeting. ....oh the ironies of the class system ... your incisive remark about the upper class complaining about the dearth of service workers also brings to mind some aspects of the immigration issue....

This is a very important subject, because honestly, do many of us even know where or how we'll end up in our "golden years?" Americans are now living longer, and that is going to translate to more of us having to plan for our retirement years.

I wouldn't mind living in a community with other seniors frankly. I don't necessarily want to be old and alone.

This post breaks my heart for its truth. The truth hurts but needs to be faced.I can't even begin to comment on this just yet, it strikes too deep. I'll come back. This post's text should be shouted from the rooftops.

This resonates with much that I have been reflecting on as I get older. Surely no one can be indifferent to old (or any) people in substandard conditions? But state intervention is not the answer IMO.

It's not that there aren't winners when the state intervenes. Of course there are. But there are more losers because the state is so inefficient. There is nothing more wasteful than "somebody else" spending "somebody else's" money. For every dollar the state spends improving someone's lot, it has probably destroyed at least as much value. That's of the money they allocate to social services. As for the torrent of money diverted to say the military, well! I believe that in the US 40% of taxes go to the military, 4% to schooling.

The point I'm making is that so many people are in substandard conditions, not because the state is indifferent (though it is), but because it actively destroys or diverts considerable wealth that would otherwise contribute to individual prosperity, if left where it belongs (i.e. with us, joe public).

Colette, having all my life defended public health, I am now utterly convinced that private health is better. Here I describe how my family paid £180K in taxes to Britain's NHS to secure perhaps £30K of medical benefit across 25 years. The NHS is widely regarded as appalling both in its wastefulness and shoddy service.

I have to admit that the fly in the ointment of my reasoning is the USA - where medicine appears to be private, expensive, and not very good.

(My apologies for going on at length - but that is a tribute to a good post!)

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